【摘要】 目的比较分析儿童和成人抗N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体脑炎在临床表现、辅助检查及免疫治疗等方面的异同。方法纳入34例抗NMDA受体脑炎患者,收集其临床资料,按发病年龄和住院科室分为儿童组和成人组,并对治疗前、后和随访(6个月~24个月)后进行改良Rankin量表(modified Rankin Scale,m RS)评分评估功能恢复结局。结果经分析19例儿童和15例成人的临床资料,儿童组和成人组发生中枢性通气不足分别有1例和10例,成人组中枢性通气不足发生率比儿童组高(P<0.05);儿童组和成人组并发继发性癫痫分别为1例和11例,并发癫痫持续状态分别为0例和5例,成人组并发继发性癫痫和癫痫持续状态比儿童组多见(P<0.05)。常规脑电图检查中,儿童组中有16例检出"δ"波,成人组有1例,儿童组"δ"波检出率更高(P<0.05)。成人组2例女性合并可疑卵巢畸胎瘤;儿童组无合并肿瘤情况。儿童组和成人组免疫治疗方案中最常使用大剂量甲强龙冲击治疗;儿童组(17例)使用静脉用丙种球蛋白冲击治疗比成人组(8例)多见(P<0.05);儿童组和成人组使用血浆置换例数比和免疫抑制剂(环磷酰胺)例数比分别为(0:5)和(1:7),成人组使用血浆置换及免疫抑制剂更多见(P<0.05)。儿童组和成人组发病至就诊的平均时间分别为(14.47±8.39)d和26d,确诊的平均时间分别为(25.42±14.36)d和(40.13±14.14)d,儿童组发病至就诊、确诊的平均时间短于成人组(P<0.05);儿童组有5例住重症监护室(ICU),比成人组(10例)少(P<0.05);出院时儿童组和成人组m RS评分分别为(2.26±1.56)分和(3.67±1.59)分,儿童组低于成人组(P<0.05)。结论成人抗NMDA受体脑炎临床症状相对复杂,病情较重,短期预后相比儿童差。更多还原

【Abstract】 ObjectiveTo compare and analyze differences in clinical characteristics, auxiliary examination and immunotherapy between children with anti-N-methyl-D-aspartate(NMDA) receptor encephalitis and adults.Methods Clinical data was retrospectively collected from 34 cases anti-NMDA receptor encephalitis. All people were divided into the child group and the adult according to the age of onset and the inpatient department. Score of Modified Rankin Scale(m RS) before and after treatment and follow-up period(6 months~24 months) were compared to estimate the neurological outcomes.ResultsData from 34 patients including 19 children and 15 adults was analyzed. Hypoventilation, epilepsy and status epilepticus were more common in the adult group than in the child. The positive rate of EEG delta brush was higher in child group than in adult group. Two women were complicated by suspicious ovarian teratoma. Intravenous immune globulin was used commonly in the child group, while the plasma exchange or immunosuppressant used common-ly in the adult group. Time of onset to hospital admission and final diagnosis were shorter in the child group than in the adult. Patients requiring ICU were fewer in the child group than in the adult. The scores of m RS were significantly lower in the child group than in the adult at hospital discharge(P<0.05).ConclusionClinical characteristics is more complicated in adults with anti-NMDA receptor encephalitis compared with children including a worse disease severity and a poorer short-term outcome.更多还原